Predicting post-surgery change in visual acuity after successful repair of macula-off retinal detachments: findings from a large prospective UK cohort study.

Objective: To identify risk factors affecting the change in visual acuity in successfully re-attached macula-off rhegmatogenous retinal detachment (RD) surgery.

Methods: A cohort study, using an online database, of visual outcomes for 2770 macula-off retinal detachments that were successfully re-attached by vitrectomy and internal tamponade. The database included detailed retinal diagrams of each detachment. Methods: The change in LogMAR visual acuity from pre-operatively to post-operatively.

Results: Male patients accounted for 64.6% of the sample and the median age was 63 years old. The median pre-operative VA was counting fingers (LogMAR 1.98); this improved to 0.30 LogMAR post-operatively. An improvement in VA of ≥0.30 LogMAR was achieved by 88.0% eyes. The change in VA model identified the preoperative VA, patient age, duration of central vision loss, lens status at follow up, extent of detachment, and the number of breaks in the detached retina, as factors influencing the change in VA. The model had an adjusted R2 of 0.749, and for 75.5% of eyes, the model prediction was within ±0.30 LogMAR of the recorded VA change.

Conclusions: Greater post-operative visual acuity improvement was more likely in eyes that were pseudophakic at follow up, and had shorter durations of central vision loss. Non modifiable factors associated with greater vision improvement included worse presenting vision, younger age, less extensive detachment and less than three breaks in the detached retina. These results confirm that prompt surgery improves functional outcomes in successfully treated macula off retinal detachments irrespective of presenting visual acuity.